1. Predictive symptoms for COVID-19 in the community: REACT-1 study of over 1 million people
- Author
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Barbara Bodinier, Paul Elliott, Matthew Whitaker, Graham S Cooke, Oliver Eales, Ara Darzi, Joshua Elliott, Helen Ward, Steven Riley, and Marc Chadeau-Hyam
- Subjects
myalgia ,RNA viruses ,Male ,Viral Diseases ,Coronaviruses ,Physiology ,Social Sciences ,Fevers ,Appetite ,Polymerase Chain Reaction ,Geographical locations ,State Medicine ,0302 clinical medicine ,Medical Conditions ,Medicine and Health Sciences ,Coughing ,Medicine ,Psychology ,Mass Screening ,030212 general & internal medicine ,Nose ,Pathology and laboratory medicine ,Virus Testing ,0303 health sciences ,Pharyngitis ,General Medicine ,Medical microbiology ,Chills ,3. Good health ,Europe ,Smell ,medicine.anatomical_structure ,Infectious Diseases ,England ,Area Under Curve ,Viruses ,Sensory Perception ,Female ,medicine.symptom ,SARS CoV 2 ,Pathogens ,Anatomy ,Research Article ,medicine.medical_specialty ,Isolation (health care) ,SARS coronavirus ,Fever ,Anosmia ,Microbiology ,Models, Biological ,Throat ,03 medical and health sciences ,Signs and Symptoms ,Diagnostic Medicine ,Internal medicine ,Humans ,False Positive Reactions ,European Union ,Mass screening ,030304 developmental biology ,Biology and life sciences ,business.industry ,SARS-CoV-2 ,Organisms ,Viral pathogens ,Cognitive Psychology ,COVID-19 ,Covid 19 ,Myalgia ,United Kingdom ,Microbial pathogens ,Cough ,Communicable Disease Control ,Cognitive Science ,Perception ,Clinical Medicine ,People and places ,business ,Physiological Processes ,Ageusia ,Contact tracing ,Neck ,Neuroscience - Abstract
Background Rapid detection, isolation, and contact tracing of community COVID-19 cases are essential measures to limit the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to identify a parsimonious set of symptoms that jointly predict COVID-19 and investigated whether predictive symptoms differ between the B.1.1.7 (Alpha) lineage (predominating as of April 2021 in the US, UK, and elsewhere) and wild type. Methods and findings We obtained throat and nose swabs with valid SARS-CoV-2 PCR test results from 1,147,370 volunteers aged 5 years and above (6,450 positive cases) in the REal-time Assessment of Community Transmission-1 (REACT-1) study. This study involved repeated community-based random surveys of prevalence in England (study rounds 2 to 8, June 2020 to January 2021, response rates 22%–27%). Participants were asked about symptoms occurring in the week prior to testing. Viral genome sequencing was carried out for PCR-positive samples with N-gene cycle threshold value < 34 (N = 1,079) in round 8 (January 2021). In univariate analysis, all 26 surveyed symptoms were associated with PCR positivity compared with non-symptomatic people. Stability selection (1,000 penalized logistic regression models with 50% subsampling) among people reporting at least 1 symptom identified 7 symptoms as jointly and positively predictive of PCR positivity in rounds 2–7 (June to December 2020): loss or change of sense of smell, loss or change of sense of taste, fever, new persistent cough, chills, appetite loss, and muscle aches. The resulting model (rounds 2–7) predicted PCR positivity in round 8 with area under the curve (AUC) of 0.77. The same 7 symptoms were selected as jointly predictive of B.1.1.7 infection in round 8, although when comparing B.1.1.7 with wild type, new persistent cough and sore throat were more predictive of B.1.1.7 infection while loss or change of sense of smell was more predictive of the wild type. The main limitations of our study are (i) potential participation bias despite random sampling of named individuals from the National Health Service register and weighting designed to achieve a representative sample of the population of England and (ii) the necessary reliance on self-reported symptoms, which may be prone to recall bias and may therefore lead to biased estimates of symptom prevalence in England. Conclusions Where testing capacity is limited, it is important to use tests in the most efficient way possible. We identified a set of 7 symptoms that, when considered together, maximize detection of COVID-19 in the community, including infection with the B.1.1.7 lineage., Joshua Elliot, Matthew Whitaker, and colleagues investigate predictive symptoms for community COVID-19 cases in the REACT-1 study., Author summary Why was this study done? The rapid detection of SARS-CoV-2 infection in the community is key to ensuring efficient control of transmission via isolation. Eligibility for community PCR testing is determined based on the reported presence of several (predetermined) symptoms, which may vary from one country to another. Quantitative evidence measuring which symptoms are the most informative of a COVID-19 infection remains scarce. What did the researchers do and find? Data were collected from over 1 million participants in the REACT-1 study (June 2020 to January 2021), for whom 26 symptoms were assayed and the results of a PCR test were available. Adopting a variable selection approach, we sought to determine the best combination of symptoms jointly and complementarily predictive of PCR positivity and investigated whether these symptoms were the same between individuals infected by the wild-type virus and those infected by the B.1.1.7 variant. We identified 7 symptoms that were jointly predictive of PCR positivity and appeared to vary only marginally across age groups: loss or change of sense of smell, loss or change of sense of taste, fever, new persistent cough, chills, appetite loss, and muscle aches. These symptoms were also predictive of the B.1.1.7 infection, together with sore throat (to a lesser extent). What do these findings mean? Taken together, these 7 symptoms can improve the detection of COVID-19 infection in the community. Using this sparse set of symptoms for test allocation would increase the number of tests performed (up to 30%–40% of symptomatic individuals being tested) but would enable up to 75% of symptomatic cases to be detected. This set of 7 symptoms is also predictive of B.1.1.7 infection and performs similarly across age groups. Its use would maximize the case detection rate in the community and would be particularly relevant in situations where test capacity is limited.
- Published
- 2021